St. Patrick's Academy  


APPLICATION FORM
IMPORTANT NOTES
  1. Parents should print the application form after submission.
  2. A hardcopy of the filled in application form along with Rs. 850/- [application fee], copy of birth certificate, (please carry the original birth certificate for verification) and copy of immunization card should be submitted to the school office, on or before 17th august 2017, 2:30pm..
SCHOOL ACCEPTS NO DONATIONS
 
  • Please complete in BLOCK CAPITALS
  • Please use one application for each student
Name of the Pupil
Academic Year
Grade into which admission is sought
Pupil's photo
( * ) Upload a recent passport size photograph of the pupil

Personal Information

STUDENT(WRITE ALL THE INFORMATION IN BLOCK CAPITALS)
Name of the Student
Nationality
Place of Birth
Sex
Religion
Passport Number
Home Address
PO Box
Sur name \ House Name
Date of Birth
Country of Birth
Community
Mother Tongue
Other language spoken
Aadhar Number
Communication Address
PO Box
Is there any siblings studying in the school ?
Is the person making the application the parent or legal guardian?
Emergency Contact Details
Contact Person
Contact Person
Contact Number
Contact Number

Academic Information

Name the Playschool/Nursery, which child attends
How would you best describe your child in the following area
Independent and Organization Skills
Personal and Social Interactions
Extra-Curricular achievements
Does your child have Special Education Needs (SEN)?
Has your child ever been diagnosed as having any of the following? Learning Disability Attention Deficit Disorder Behavioural Problem Physical Disability None
Please provide any further information (Ex. Personal, Medical, etc.)
   

Medical Information ( Personal Health )

Does your ward suffer from any of these following? (please choose)
Asthma/ Respiratory Problems Hay fever
Hearing Problems Epilepsy
None
Eyesight Problem Diabetes
Skin Problem Other (please give details)
Has your ward had any surgical procedures
Does your ward have any known allergies and / or dietary requirements
If yes to any of the above please provide detailed medical report. (After confirming admission)
VACCINATIONS
Tick all that apply and in addition, attach a copy of vaccinations:
Tuberculosis BCG Polio
Diphtheria/Tetanus/Pertussis(DTP) Rabies
Measles/Mumps/Rubella(MMR) Typhoid
Meningitis Hib
Chicken Pox Hepatitis
None

I/we understand that whilst the school will make all reasonable efforts to contact me/us in case of medical emergency, this is not always possible. Therefore I/we authorize the school to seek medical advice and treatment for our child if the school believes there to be an emergency and I/we hereby undertake to pay all costs incurred by the school.

I/we also hereby authorize/ do not authorize the school to give our child minor medications
(ex. crocin, paracetamol tablets) if deemed necessary by the school.

Family / Legal Guardian's Information

FATHER'S DETAILS
First Name
Occupation
Mobile No
Email
Passport No(if any)
Sur Name
Annual Income
Office No
Residence No
Aadhar No.
Educational Qualification
As a parent, areas in which you can contribute towards the enrichment of the school
MOTHER'S DETAILS
First Name
Occupation
Mobile No
Email
Passport No(if any)
Sur Name
Annual income
Office No
Residence No
Aadhar No.
Educational Qualification
As a parent, areas in which you can contribute towards the enrichment of the school
GUARDIAN'S DETAILS
First Name
Occupation
Mobile No
Email
Passport No(if any)
Sur Name
Annual Income
Office No
Residence No
Aadhar No.
Educational Qualification
COMMUNICATION DETAILS
Whether the pupil living with:
Who should receive regular correspondence from the school?
I / to have our phone number and email details published in the school community phone book and class list
I / to give permission for photograph of my child to be used in SPA website or for any school purposes
Who is responsible for the payment of the school fees?
Payment structure will be
School Bus
Rules & Regulations
I am fully aware that continuance of my child/ward in St. Patrick’s Academy, Angamaly, depends entirely on following the ‘Rules and Regulations’ of the School as incorporated in the ‘SCHOOL PROSPECTUS’ and in the ‘SCHOOL DIARY’.
DECLARATION
I/we hereby certify that the above information provided by me/us is correct and I/we understand that if the information is found to be incorrect, the ward shall be automatically debarred from selection/ admission procedure without any correspondence in this regard. I/we also understand that the application, registration/short listing does not guarantee admission to my ward. I/we accept the process of admission undertaken by the school and I/we abide by the decision taken by the school authorities.
INDEMNITY BOND
I agree to my child participating in any educational activities arranged by the school. This includes any field trips. In the event of injury to my child or damage to the property of my child while he or she is participating in such activities, or while on SPA premises or being transported to or from the school, I will not hold the school or any member of the school staff responsible. The school undertakes, in the event of an emergency, to make every effort to contact the parents. If this is not possible the child will be taken either to nearest doctor, or to a suitable hospital for treatment.
Father's Photo Mother's Photo
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Dear parents,

Please write below reasons why you are seeking admission for your child in St. Patrick's Academy, Angamaly. (maximum of 100 words)


 


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